Role of CT in excluding major arterial injury after blunt thoracic trauma

• Published in: American journal of roentgenology (1976) Vol. 149; no. 3; pp. 601 - 605
• Main Authors: Mirvis, SE, Kostrubiak, I, Whitley, NO, Goldstein, LD, Rodriguez, A
• Format: Journal Article
• Language: English
• Published: Leesburg, VA Am Roentgen Ray Soc 01-09-1987; American Roentgen Ray Society
• Subjects: Adolescent; Adult; Aged; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - injuries; Biological and medical sciences; Child; Female; Hematoma - diagnostic imaging; Humans; Male; Mediastinal Diseases - diagnostic imaging; Medical sciences; Middle Aged; Thoracic Arteries - diagnostic imaging; Thoracic Arteries - injuries; Thoracic Injuries - diagnostic imaging; Tomography, X-Ray Computed; Traumas. Diseases due to physical agents; Vascular injuries: limbs, aorta, vena cava; Wounds, Nonpenetrating - diagnostic imaging; Human; Radiodiagnosis; Aorta; Cardiovascular disease; Thorax; Computerized axial tomography; Trauma; Artery; Contrast media
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/ajr.149.3.601

The role of CT in the diagnosis of major vascular rupture following blunt decelerating chest trauma is controversial. Its value in excluding major arterial injury has not yet been determined. During a 12-month period we obtained dynamic enhanced thoracic CT studies in 20 patients with blunt decelerating thoracic trauma who had abnormal or equivocal mediastinal contours on chest radiographs. In all cases diagnosis was confirmed by either digital subtraction (18 patients) or conventional thoracic angiography (two patients). CT scans showed evidence of direct aortic injury in three patients and evidence of mediastinal hematoma in five others. Four of these eight patients had major arterial injury verified angiographically and at surgery. In two patients the CT scan was considered equivocal; both patients had normal thoracic angiograms. CT excluded direct vascular injury or mediastinal hematoma in 10 patients. All 10 had normal thoracic angiograms. This preliminary study suggests that, in patients sustaining blunt decelerating thoracic trauma, thoracic CT may be more valuable than chest radiography in excluding major vascular injury and, in some cases, may reduce the need for thoracic angiography.